Intake Specialist II - Post Acute

Job Summary:The Intake Specialist II - Post Acute is responsible for coordinating level of care transition and post-acute UM activities to ensure compliance with timely processing of authorization, level of care, and disenrollment requests. The Specialist processes requests into clinical systems for review, contacts the provider, member, or other stakeholder if additional and/or clinical information is required, and communicates with stakeholders to complete disenrollment functions and support members to maintain program eligibility.Essential Functions:Convert information obtained from providers, members, care coordinators/care managers, waiver service coordinators, or other stakeholders (received via fax, phone, provider portal or mail) into electronic records while verifying member eligibility, provider network status, and benefit coverage; communicate information to appropriate team members via established processes within the clinical documentation system or other communication methodsReview requests and communicate changes in eligibility , duplicate requests, and items not covered by medical benefit to providers or other stakeholdersInitiate process for routing prior authorizations or level of care reviews requiring medical necessity review by clinical staffCommunicate with providers, care coordinators/care managers, waiver service coordinators, or other stakeholders regarding prior authorization, level of care, or disenrollment requests and outcomes; provide support to providers as appropriate.Provide authorization, level of care, or disenrollment information to provider, facility, member, care coordinator/care manager, waiver service coordinator and/or other stakeholders per established processes or upon request.Assist Clinical team as directed to ensure requests for authorization or level of care that require clinical review are received and processed timelyAssist clinical teams and leaders in gathering data for reportingAssist in processing disenrollment requests in required systems and document actions in clinical documentation systemMaintain awareness of current workload aging and respond with appropriate sense of urgencyExpectation to meet department standards and goalsCollaborate across company departments to assist with issues and questionsMaintain knowledge and understanding of all processes and procedures for multiple marketsSufficiently cross-trained in multiple markets and productsAdhere to all departmental and company policies and proceduresPerform any other job related instructions, as requestedEducation and Experience:High School Diploma or equivalent requiredMinimum of eighteen (18) months of clinical and/or insurance experience, or related healthcare education or certification (i.e. STNA, MA, etc.) is requiredManaged care experience preferredExperience with post-acute, nursing facility and/or HCBS waiver services is preferredCompetencies, Knowledge and Skills:Computer proficiency with knowledge and experience with Microsoft Office in a Windows based environmentAbility to analyze informationCommunication skillsAbility to work independently and within a team environmentAttention to detailProper grammar usageCritical listening and thinking skillsProfessional phone etiquetteCustomer service orientedDecision making/problem solvingChange resiliencyKnowledge of behavioral health systemsAbility to accurately communicate summary information in a written formatLicensure and Certification:Medical Terminology Certificate is preferredWorking Conditions:General office environment; may be required to sit/stand for long periods of timePosition requires the flexibility to work evenings, weekends and/or holidays, as neededCompensation Range:$40,400.00 - $64,700.00CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.Compensation Type (hourly/salary):HourlyOrganization Level Competencies Create an Inclusive EnvironmentCultivate PartnershipsDevelop Self and OthersDrive ExecutionInfluence OthersPursue Personal ExcellenceUnderstand the BusinessThis job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.Originally posted on Himalayas

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